Mara Caterina BĂLAN, Mihai Emilian LĂPĂDAT, Anca Mariana CIOBANU, Irina Nicoleta TRIANTAFYLLIDIS, Oana STANCA
Abstract
Objectives: Real-life data on IgA-secretory multiple myeloma tends to suggest a more unfavorable prognosis due to its aggressive nature and clinical features, without clear arguments in favor of this theory in literature. In this paper our aim was to collect clinical and paraclinical features at diagnosis and to evaluate the response to the first line of treatment in a cohort of patients from our clinic.
Material and methods: A retrospective study on a cohort of 32 patients diagnosed at the Hematology Clinic of Colțea Clinical Hospital between 2021-2023. Clinical and biological data that were selected at diagnosis for descriptive analysis include: age, sex, complete blood count, inflammatory markers, beta2 microglobulin, plasma cell infiltrate, serum creatinine, serum total protein, serum calcium, albumin, monoclonal protein, extramedullary disease and response to first-line of therapy.
Outcomes: The median age at diagnosis was 62 years. One-third (34.3%) of patients presented with hypercalcemia (≥11 mg/dl) and 25% of patients had renal impairment according to the diagnostic criteria. A significant percentage of patients (43.75%) had bone implication at diagnosis. Regarding response to first-line therapy, 50% did not meet the response criteria (considered as complete response, very good partial response or partial response). Proinflammatory status of patients (particularly erythrocyte sedimentation rate (ESR) >115 mm/h) was found to be statistically correlated with response. Other factors that were found to have a negative impact on treatment response were: age≥65 years, lactate dehydrogenase (LDH) > upper limit of normal (ULN) and serum creatinine ≥2 mg/dl. High values of beta2-microglobulin (b2M) proved to be statistically correlated with pathologic bone fractures.
Conclusions: IgA-secretory myeloma comprises a low incidence subcategory of myeloma characterized by a high percentage of extramedullary disease and bone lesions. The proinflammatory microenvironment is a central element in myeloma pathology. The majority of the patients in the cohort (80%) presented with hyperviscosity, and we demonstrated a direct proportional relationship between ESR, C-reactive protein (CRP) and b2M. In the present study there was a correlation between the value of beta2-microglobulin and pathologic bone fractures. Another central element in the pathogenesis of MM is immunosuppression, which we confirmed in this study by the presence of low IgG values (91%).
Keywords: IgA multiple myeloma, prognostic factors, beta-2 microglobulin, first line therapy, erythrocyte sedimentation rate
https://doi.org/10.59854/dhrrh.2024.2.4.201
